Epidemiology and management of gestational diabetes

The Lancet, Год журнала: 2024, Номер 404(10448), С. 175 - 192

Опубликована: Июнь 20, 2024

Язык: Английский

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Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes: A Scientific Statement From the American Heart Association

Circulation, Год журнала: 2024, Номер 149(7)

Опубликована: Фев. 12, 2024

Adverse pregnancy outcomes are common among pregnant individuals and associated with long-term risk of cardiovascular disease. Individuals adverse also have an increased incidence disease factors after delivery. Despite this, evidence-based approaches to managing these patients reduce lacking. In this scientific statement, we review the current evidence on interpregnancy postpartum preventive strategies, blood pressure management, lifestyle interventions for optimizing using American Heart Association Life's Essential 8 framework. Clinical, health system, community-level can be used engage reach populations who experience highest burden Future trials needed improve screening subclinical in a history outcomes, before onset symptomatic Interventions fourth trimester, defined as 12 weeks delivery, great potential across life course.

Язык: Английский

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Comparing advanced hybrid closed loop therapy and standard insulin therapy in pregnant women with type 1 diabetes (CRISTAL): a parallel-group, open-label, randomised controlled trial

The Lancet Diabetes & Endocrinology, Год журнала: 2024, Номер 12(6), С. 390 - 403

Опубликована: Апрель 30, 2024

Язык: Английский

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Mechanisms of action and therapeutic applications of GLP-1 and dual GIP/GLP-1 receptor agonists

Frontiers in Endocrinology, Год журнала: 2024, Номер 15

Опубликована: Июль 24, 2024

Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are two incretins that bind to their respective receptors activate the downstream signaling in various tissues organs. Both GIP GLP-1 play roles regulating food intake by stimulating neurons brain's satiety center. They also stimulate insulin secretion pancreatic β-cells, but effects on glucagon production α-cells differ, with having a glucagonotropic effect during hypoglycemia exhibiting glucagonostatic hyperglycemia. Additionally, directly stimulates lipogenesis, while indirectly promotes lipolysis, collectively maintaining healthy adipocytes, reducing ectopic fat distribution, increasing of adiponectin from adipocytes. Together, these contribute metabolic homeostasis, preventing both hyperglycemia hypoglycemia, mitigating dyslipidemia, risk cardiovascular diseases individuals type 2 diabetes obesity. Several dual GIP/GLP-1 receptor agonists have been developed harness pharmacological treatment diabetes, some demonstrating robust effectiveness weight management prevention diseases. Elucidating underlying cellular molecular mechanisms could potentially usher development new generations incretin mimetics enhanced efficacy fewer adverse effects. The guidelines evolving based clinical trial outcomes, shaping

Язык: Английский

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Randomized Trial of Assisted Hybrid Closed-Loop Therapy Versus Sensor-Augmented Pump Therapy in Pregnancy

Diabetes Technology & Therapeutics, Год журнала: 2024, Номер 26(8), С. 547 - 555

Опубликована: Фев. 22, 2024

Examine gestational safety, glycemic and health outcomes, of a hybrid closed-loop (HCL) system without pregnancy-specific glucose targets.

Язык: Английский

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Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes

JAMA, Год журнала: 2025, Номер unknown

Опубликована: Янв. 6, 2025

Importance Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results noninferior perinatal outcomes compared with alone is unknown. Objective To test whether treatment glucose-lowering for prevention large-for-gestational-age infants. Design, Setting, Participants Randomized, open-label noninferiority trial conducted at 25 Dutch centers from June 2016 November 2022 follow-up completed May 2023. The study enrolled 820 individuals diabetes singleton pregnancies between 16 34 weeks gestation who had insufficient glycemic control after 2 dietary changes (defined fasting glucose >95 mg/dL [>5.3 mmol/L], 1-hour postprandial >140 [>7.8 or 2-hour >120 [>6.7 measured by capillary self-testing). Interventions were randomly assigned receive metformin (initiated dose 500 mg once daily increased every 3 days 1000 twice highest level tolerated; n = 409) (prescribed according local practice; 411). Glyburide was added metformin, then substituted glyburide, if needed, achieve targets. Main Outcomes Measures primary outcome the between-group difference percentage infants born large age (birth weight >90th percentile based on sex). Secondary included maternal hypoglycemia, cesarean delivery, pregnancy-induced hypertension, preeclampsia, gain, preterm birth injury, neonatal hyperbilirubinemia, intensive care unit admission. Results Among participants, mean 33.2 (SD, 4.7) years). In participants randomized agents, 79% (n 320) maintained without insulin. With 23.9% 97) vs 19.9% 79) (absolute risk difference, 4.0%; 95% CI, −1.7% 9.8%; P .09 noninferiority), confidence interval exceeding absolute margin 8%. Maternal hypoglycemia reported 20.9% 10.9% 10.0%; 3.7%-21.2%). All other secondary did not differ groups. Conclusions Relevance Treatment additional meet criteria respect proportion age. Trial Registration Netherlands Registry Identifier: NTR6134

Язык: Английский

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Drug Therapies for Diabetes

International Journal of Molecular Sciences, Год журнала: 2023, Номер 24(24), С. 17147 - 17147

Опубликована: Дек. 5, 2023

The treatment of type 2 diabetes (T2D) necessitates a multifaceted approach that combines behavioral and pharmacological interventions to mitigate complications sustain high quality life. Treatment encompasses the management glucose levels, weight, cardiovascular risk factors, comorbidities, associated through medication lifestyle adjustments. Metformin, standard in management, continues serve as primary, first-line oral across all age groups due its efficacy, versatility combination therapy, cost-effectiveness. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) offer notable benefits for HbA1c weight reduction, with significant benefits. Sodium-glucose cotransporter inhibitors (SGLT-2i) lower levels independently insulin while conferring cardiovascular, renal, heart-failure outcomes. Combined therapies emphasizing early sustained glycemic control are promising options management. As therapy remains pivotal, metformin non-insulin agents such GLP-1 RA SGLT-2i compelling options. Notably, exciting novel treatments like dual GLP-1/ glucose-dependent insulinotropic polypeptide (GIP) agonist show promise substantially reducing glycated hemoglobin body weight. This comprehensive review highlights evolving landscape pharmacotherapy diabetes, drugs currently available treating their effectiveness impact on target organs, side effects. work also provides insights can support customization strategies.

Язык: Английский

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Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy

JAMA, Год журнала: 2023, Номер 330(22), С. 2182 - 2182

Опубликована: Дек. 12, 2023

Importance Insulin is recommended for pregnant persons with preexisting type 2 diabetes or diagnosed early in pregnancy. The addition of metformin to insulin may improve neonatal outcomes. Objective To estimate the effect added pregnancy on a composite adverse outcome. Design, Setting, and Participants This randomized clinical trial 17 US centers enrolled adults aged 18 45 years prior 23 weeks’ gestation between April 2019 November 2021. Each participant was treated assigned add either placebo. Follow-up completed May 2022. Intervention Metformin 1000 mg placebo orally twice per day from enrollment (11 weeks -<23 weeks) through delivery. Main Outcome Measures primary outcome complications including perinatal death, preterm birth, large small gestational age, hyperbilirubinemia requiring phototherapy. Prespecified secondary outcomes included maternal hypoglycemia fat mass at prespecified subgroup analyses by body index less than 30 vs greater those Results Of 831 participants randomized, 794 took least 1 dose study agent were analysis (397 group 397 group). Participants’ mean (SD) age 32.9 (5.6) years; 234 (29%) Black, 412 (52%) Hispanic. occurred 280 (71%) 292 (74%) (adjusted odds ratio, 0.86 [95% CI 0.63-1.19]). most commonly occurring events both groups hypoglycemia, delivery large-for-gestational-age infant. halted 75% accrual futility detecting significant difference similar groups. individual components outcome, metformin-exposed neonates had lower be 0.63 CI, 0.46-0.86]) when compared group. Conclusions Relevance Using plus treat did not reduce reduction infant observed after adding warrants further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT02932475

Язык: Английский

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Safety and efficacy of the new, oral, small-molecule, GLP-1 receptor agonists orforglipron and danuglipron for the treatment of type 2 diabetes and obesity: systematic review and meta-analysis of randomized controlled trials

Metabolism, Год журнала: 2023, Номер 149, С. 155710 - 155710

Опубликована: Окт. 16, 2023

Язык: Английский

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Real-world evidence of off-label use of commercially automated insulin delivery systems compared to multiple daily insulin injections in pregnancies complicated by type 1 diabetes

Diabetes Technology & Therapeutics, Год журнала: 2024, Номер unknown

Опубликована: Фев. 28, 2024

Aims: To compare glycemic control and maternal–fetal outcomes of women with type 1 diabetes (T1D) using hybrid closed loop (HCL) vs. multiple daily insulin injections (MDI) plus continuous glucose monitoring (CGM). Methods: Multicenter prospective cohort study pregnant T1D in Spain. We evaluated HbA1c time spent within (TIR), below (TBR) above (TAR) the pregnancy-specific range 3.5–7.8 mmol/L. Adjusted models were performed for adverse pregnancy including baseline maternal characteristics center. Results: 112 included (HCL n=59). Women HCL group had a longer duration higher rates prepregnancy care. There no between-group differences any trimester. However, second trimester, MDI users greater decrease (-6.12±9.06 -2.16 ±7.42 mmol/mol, p=0.031). No TIR (3.5-7.8 mmol/L) TAR observed between users, but total dose trimester (+0.13 IU/Kg/d). therapy was associated increased weight gain during (βadjusted 3.20 kg, 95%CI 0.90-5.50). Regarding neonatal outcomes, newborns more likely to have birthweight 279.0 g, 95% CI 39.5-518.5) macrosomia (ORadjusted 3.18, 1.05-9.67) compared users. These associations disappeared when or third models. Conclusions: In real-world setting, gained larger than while achieving similar terms TIR.

Язык: Английский

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